LONDON June 28 2007--A cervical cancer vaccine has shown 90%efficacy for prevention of cervical cancer and precancerous lesionsassociated with the human papillomavirus (HPV) types targeted bythe vaccine conclude authors of an Article published early Onlineand in the upcoming issue of The Lancet. HPV types 16 and 18 account for 70% or morecases of cervical cancer worldwid

LONDON, June 28, 2007--A cervical cancer vaccine has shown 90%
efficacy for prevention of cervical cancer and precancerous lesions
associated with the human papillomavirus (HPV) types targeted by
the vaccine, conclude authors of an Article published early Online
and in the upcoming issue of The Lancet.

HPV types 16 and 18 account for 70% or more
cases of cervical cancer worldwide, but there are up to 15
oncogenic HPV types which can contribute to cervical cancer.

Professor Jorma Paavonen, Department of
Obstetrics and Gynaecology, University of Helsinki, Finland, and
colleagues randomly assigned 9 258 women to receive the HPV 16/18
vaccine, and 9 267 women in a control group received Hepatitis A
vaccine. Women who may have already been infected with HPV were
included in the study, as were women who had low-grade cytological
abnormalities at study entry.

With an average follow-up of 15 months, the
investigators found the vaccine had 90·4% efficacy against
high-grade cervical intraepithelial neoplasia (CIN 2/3, a cervical
cancer precursor) associated with HPV types 16 and 18. They found
also that many CIN lesions contained several oncogenic HPV types.
The level of protection against persistent infections with HPV16/18
at 6 and 12 months was 80·4% and 75·9%, respectively.
The study extended earlier results of cross-protection against HPV
45 and HPV 31, which cause up to 10% of cases of cervical
cancer.

The authors say: "Our results show that the
vaccine is effective, well-tolerated and immunogenic in a broad
population of young adult women, lending support to its potential
value in preventing CIN and cervical cancer."

In an accompanying Comment, Dr Jessica Kahn,
Cincinnati Children’s Medical Center, University of
Cincinnati College of Medicine, USA, and Dr Robert Burk, Albert
Einstein College of Medicine, New York, USA, state: "Althou
gh these
interim efficacy data are encouraging, their interpretation has
limitations. The follow-up was brief, given that cervical
carcinogenesis often evolves over several decades. They also
highlight increases in adverse reactions among women in the HPV
vaccine group.

Finally, the Comment authors raise the issue of
ensuring the vaccine is distributed in the developing world, where
cervical cancer makes the largest contribution to years of life
lost to cancer, concluding: "Poverty is strongly associated with
high-risk HPV infection and cervical cancer. If those who live in
poverty cannot access a highly effective intervention such as HPV
vaccines, disparities could worsen dramatically."

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